大脑后动脉偏侧优势对同侧大脑中动脉病变卒中严重程度及预后的影响

发布时间：2018-05-15 06:38

本文选题：脑梗死 + 大脑中动脉　；参考：《中国卒中杂志》2017年04期

【摘要】：目的探讨同侧大脑后动脉偏侧优势(posterior cerebral artery laterality,PCAL)对同侧大脑中动脉(middle cerebral artery,MCA)M1段严重狭窄或闭塞后急性卒中患者梗死范围、卒中严重程度和短期预后的影响。方法于2010年1月-2015年11月,前瞻性连续性纳入郑州大学第一附属医院MCA M1段严重狭窄(狭窄率70%~90%)或闭塞的161例急性缺血性卒中患者,根据患者有无PCAL分组,比较两组临床基线资料及3个月随访改良Rankin量表(modified Rankin scale,mRS)评分的差异。结果 161例患者中共76例PCAL阳性,85例PCAL阴性。PCAL阳性组既往卒中者少(P=0.021),基于弥散加权成像的Alberta卒中项目早期CT评分(diffusion weighted imaging-Alberta Stroke Programme Early CT Score,DWI-ASPECTS)更高(P=0.045),出院时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分更低(P=0.009),3个月mRS评分更低(P=0.002),临床短期预后更好,差异有显著性。多因素Logistic回归分析可见,入院NIHSS评分[OR(odds ratio)1.266,95%CI(confidence interval)1.139~1.407,P0.01]是预后不良的预测因子,PCAL阳性(OR 0.355,95%CI 0.146~0.864,P=0.022)是预后良好的预测因子。结论 MCA M1段严重狭窄或闭塞的急性缺血性卒中患者,PCAL阳性者梗死范围更小,短期临床预后更好。
[Abstract]:Objective to investigate the effect of posterior cerebral artery lateral cerebral artery (PCAL) on infarct size, stroke severity and short-term prognosis in patients with acute stroke after severe stenosis or occlusion of middle cerebral artery in ipsilateral middle cerebral artery (MCAM1). Methods from January 2010 to November 2015, 161 patients with acute ischemic stroke who were included in the prospective consecutive study in the first affiliated Hospital of Zhengzhou University, MCA M1 segment, were divided into three groups according to whether the patients had PCAL or not. The clinical baseline data and the modified Rankin scale (modified Rankin scale mRSs) scores were compared between the two groups. Results A total of 76 cases of PCAL positive and 85 cases of PCAL negative. PCAL positive group with previous stroke were less P0. 021. The early CT score of Alberta stroke project based on diffusion-weighted imaging was higher than that of weighted imaging-Alberta Stroke Programme Early CT ScoreDWI-ASPECTS. The National Institutes of Health of the United States of America was discharged from the hospital. The National Institutes of Health Stroke scale (NIHSS) score was lower (P < 0.009), and the mRS score was lower (P < 0.002) at 3 months. The clinical short-term prognosis was better. The difference was significant. Multivariate Logistic regression analysis showed that the NIHSS score of admission [OR(odds confidence intervalency 1.139 / 1.407 / P0.01] was a positive predictor of poor prognosis (OR 0.35595 CI 0.1460.864P0. 022) and was a good predictor of prognosis. Conclusion the infarct size of acute ischemic stroke patients with severe stenosis or occlusion of MCA M1 segment is smaller and the short-term prognosis is better.
【作者单位】：郑州大学第一附属医院神经内三科;
【分类号】：R743.3

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